The Transitional v. Metropolitan Life

CourtCourt of Appeals for the Fifth Circuit
DecidedOctober 10, 1996
Docket96-40154
StatusUnpublished

This text of The Transitional v. Metropolitan Life (The Transitional v. Metropolitan Life) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
The Transitional v. Metropolitan Life, (5th Cir. 1996).

Opinion

IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT _______________

No. 96-40154 Summary Calendar _______________

THE TRANSITIONAL LEARNING CENTER AT GALVESTON,

Plaintiff-Appellee,

VERSUS

METROPOLITAN LIFE INSURANCE COMPANY,

Defendant-Appellant.

_________________________

Appeal from the United States District Court for the Southern District of Texas (G-95-17) _________________________ October 19, 1996

Before SMITH, DUHÉ, and BARKSDALE, Circuit Judges.

JERRY E. SMITH, Circuit Judge:*

Metropolitan Life Insurance Company (“MetLife”) appeals the

award of attorneys’ fees and prejudgment interest to the Transi-

tional Learning Community at Galveston (“TLC”) under the Employee

Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C.

§§ 1001-1461 (West 1985 & Supp. 1995). We affirm in part and

* Pursuant to 5TH CIR. R. 47.5, the court has determined that this opinion should not be published and is not precedent except under the limited circumstances set forth in 5TH CIR. R. 47.5.4. vacate and remand in part.

I.

TLC sued MetLife in state court in November 1994, alleging

that MetLife had failed to reimburse TLC for various medical

expenses incurred in connection with its treatment of Angela

Sibley, a dependent of an insured under a MetLife medical insurance

policy. MetLife removed this action to federal court on the same

day that the state court, after MetLife had failed to appear,

entered a default judgment on TLC’s claims. The district court

later reformed the state court judgment to reflect the parties’

subsequent agreement to the proper amount of monies owed. Upon

motion, the court awarded TLC attorneys’ fees and pre- and post-

judgment interest on the amount of the reformed judgment.

We address first MetLife’s argument that this case should be

dismissed because TLC failed to exhaust its administrative remedies

under the ERISA-regulated plan prior to filing the instant action.

According to MetLife, the disposition of the instant claim had been

held up for over two years because TLC failed to provide a

completed Statement of Continued Disability from the plan adminis-

trator. Once TLC forwarded the completed statement to MetLife, the

claim was settled promptly.

Although we agree with MetLife that TLC may have failed to

exhaust its administrative remedies, we refuse to dismiss the

instant action, as MetLife did not raise this objection timely.

2 When TLC filed its original action, MetLife had ample opportunity

to raise its exhaustion defense, and we will not reward it for

failing even to appear in that action. That MetLife chose not to

answer TLC’s complaint in state court, but rather compelled the

state court to enter a default judgment against it, constituted

waiver of its right to assert an exhaustion defense. The district

court found, properly, that MetLife did not proffer any reasonable

justification for its failure to appear in the state court action,

and thus we do not believe that it is prejudiced unduly by its

failure to assert its defenses timely.

MetLife correctly asserts that we have applied the exhaustion

doctrine in suits arising under ERISA, see Medina v. Anthem Life

Ins. Co., 983 F.2d 29, 33 (5th Cir.), cert. denied, 510 U.S. 816

(1993), but we have never construed the doctrine strictly as a

jurisdictional bar, see id. (noting that plaintiff did not exhaust

her remedies because she had never filed a claim for the disputed

sum); Simmons v. Willcox, 911 F.2d 1077, 1081 (5th Cir. 1990)

(noting that plaintiff did not exhaust her remedies because she had

failed to file any claim for benefits with the insurer); Meza v.

General Battery Corp., 908 F.2d 1262, 1279 (5th Cir. 1990)(noting

that the plaintiff did not exhaust her remedies because she never

requested plan information or applied for benefits prior to filing

suit). Rather, we have held that sound public policy underlies the

application of the doctrine to ERISA, see id. at 1279, and the same

3 applies in the instant case: MetLife could have facilitated the

prompt and efficient disposition of an ERISA claim by appearing in

state court and raising its exhaustion defense in that forum.

II.

MetLife next challenges the award of attorneys’ fees. We

review this for abuse of discretion. See Ramsey v. Colonial Life

Ins. Co. of Am., 12 F.3d 472, 480 (5th Cir. 1994).

After reviewing the five factors1 used in this circuit, the

district court concluded that

[t]he record fails to show that any of the first four factors listed in Bowen weigh significantly in favor of either granting or denying attorneys’ fees. Nonetheless, consideration of the final factor, viewed in light of Defendant’s initial refusal to pay Plaintiff the owing funds and subsequent failure to contest liability in a proper or reasonable manner, persuades this Court to award Plaintiff the requested attorneys’ fees.

913 F. Supp. 504, 506-07 (S.D. Tex. 1996) (emphasis added).

MetLife interprets these sentences “clearly [to] state[]” that the

court reached its decision “solely on the basis of the relative

1 The five factors are:

(1) the degree of the opposing parties’ culpability or bad faith; (2) the ability of the opposing parties to satisfy an award of attorneys’ fees; (3) whether an award of attorneys’ fees would deter other persons from acting under similar circumstances; (4) whether the parties requesting attorneys’ fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA itself; and (5) the relative merits of the parties’ positions.

Iron Workers Local No. 272 v. Bowen, 624 F.2d 1255, 1266 (5th Cir. 1980).

4 merits of the parties’ positions.” MetLife next protests that,

because the court failed to assess the merits properly, the award

should be reversed.

We disagree. As a preliminary matter, the district court did

not state expressly that the first four factors were inapposite to

the decision, but rather that none on its own significantly cut in

favor of an award.

“[I]n light of Defendant’s initial refusal to pay Plaintiff

the owing funds and subsequent failure to contest liability in a

proper or reasonable manner,” 913 F. Supp. at 506-07, the court

made plain that MetLife’s culpability or bad faith (the first Bowen

factor) became significant when considered along with the merits.

That the court could have been more lucid in its explication of the

Bowen factors is not reversible error as long as such factors guide

the decision-making process. See Harms v. Cavenham Forest Indus.,

984 F.2d 686, 694 (5th Cir.)(“No one of these factors is necessar-

ily decisive, and some may not be apropos in a given case, but

together they are the nuclei of concerns that a court should

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